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The application does not have to be completed in one sitting, if you would like to save your application and return to it at a later time you may do so by clicking the Click and Save button located on the bottom left hand side of the application.

You will be able to complete this form from your computer, tablet, or phone. Unfortunately, we are only able to accept applications from candidates who can attend the workshop and complete the online modules. If you would like to be considered for future training sessions or would like to provide more information to the training team, please arboles georgetown. Section 1: Participation Requirements Which of these trainings will you be available to attend? To increase your chances of being accepted, please select all training options that work for your schedule.

Yes No. No, I don't have adequate internet access for this kind of use. Yes, I feel comfortable using Zoom I would like additional support. Yes, currently employed Yes, currently volunteer No. Please include two professional references from your organization who can testify about your role as a volunteer Reference One Name First Last.

Reference Two Name First Last. Save and Continue Later. Telephone . Female Male. Patient education Patient Community education Community outreach Training of other colleagues Other. Section 3: Educational Background Please list your education in chronological order starting with the most recent first.

Institution and Location:. Licensures or Certifications Check any that apply. Section 4: Workplace Setting 1. Which of the following best describes your workplace or volunteer place? No Not Sure Yes. Staff member Local genetic Counselor Local doctor. As part of one to one patient education one patient at a time As part of community education Not Sure We do not yet educate community members about hereditary breast and ovarian cancer. At least times a week Once a week times a month Once a month times a year Once a year Less than once a year Never.

Text message whatsapp reminders reminders Other. Section 7: Attitudes and Opinions about Genetic Testing Genetic counseling examines the hereditary basis of cancer and offers support and guidance to individuals considering whether or not to undergo genetic testing. How much have you heard or read about genetic counseling for cancer? How much have you heard or read about genetic counseling for ovarian cancer? How much have you heard or read about genetic counseling for colon cancer? Please try to complete all items even if you are unsure of an answer. True False Don't Know A father can pass down an altered breast cancer gene to his children.

One half of all breast cancer cases occur in women who have an altered breast cancer gene. All women who have an altered breast cancer gene get cancer. A woman who does not have an altered breast cancer gene can still get breast or ovarian cancer. Early-onset breast cancer is more likely due to an altered breast cancer gene than is late-onset breast cancer.

One in 10 women has a breast cancer gene mutation. A woman who has an altered breast cancer gene has a higher ovarian cancer risk. Having ovaries removed will definitely prevent ovarian cancer. A woman who has her breasts removed can still get breast cancer. Ovarian cancer screening tests often do not detect cancer until after it spre.

Section 8: Genetic Literacy Scale The words below are words related to genetics that people sometimes struggle with. We first list a word and then ask how familiar you are with each word. Marking "7" on the scale reflects that you strongly agree, marking "1" on the scale means that you strongly disagree. Please choose the that best reflects your opinion. The second question asks you to choose the best word which fills in the blank.

Strongly disagree 1. Strongly agree 7. Generations Experiences Exposures Germinations. Genetic Digestive Cellular Brain. Eventually will Definitely will Might Will never. All of the time Some of the time Never Only in animals. A trachea Brown hair Trisomy Blood pressure. The environment to the person The sick to the healthy Parent to child Teacher to student.

Symptoms A family history A diagnosis Medication. Section 9: Genetic Counseling and Testing Perceived Benefits and Barriers We have a few more questions about your thoughts about genetic counseling and testing. Let us know how much you agree or disagree with each one. If a genetic counselor spoke Spanish, Latinas in my community would be more likely to have genetic counseling. If Latinas in my community had to travel to a hospital to have genetic counseling, they would not go. If Latinas in my community knew they carried a gene for hereditary breast and ovarian cancer, they would be motivated to perform breast self-examination more frequently.

If Latinas in my community were found to carry a gene for hereditary breast and ovarian cancer, it would help their daughters or sisters decide whether to undergo genetic testing. For Latinas in my community, knowing that they carry a gene for hereditary breast and ovarian cancer would help them decide whether to go for more frequent mammograms. If Latinas in my community knew whether or not they carried a gene for hereditary breast and ovarian cancer, their senses of uncertainty about the future would be reduced.

If Latinas in my community knew whether or not they carried a gene for hereditary breast and ovarian cancer, their senses of personal control would be increased. If Latinas in my community knew that they did not carry a gene for hereditary breast and ovarian cancer, their qualities of life would be greatly improved. If Latinas in my community knew that they did not carry a gene for hereditary breast and ovarian cancer, their concerns about developing having a recurrence of breast cancer would be reduced.

If Latinas in my community knew that they did not carry a gene for hereditary breast and ovarian cancer, it would improve how they feel about themselves. If Latinas in my community knew that they carried a gene for hereditary breast and ovarian cancer, their concerns about their female offspring developing breast cancer would increase. If Latinas in my community knew that they did not carry a gene for hereditary breast and ovarian cancer, it would not be helpful since their offspring could still develop breast cancer.

If Latinas in my community knew that they carried a gene for hereditary breast and ovarian cancer, it would cause them to worry more about other family members who could be carriers e. For Latinas in my community, concerns about developing breast cancer would increase if they knew that they carried a gene for hereditary breast and ovarian cancer. If Latinas in my community knew that they did not carry a gene for hereditary breast and ovarian cancer, it would not be helpful since they could still develop breast cancer. If Latinas in my community knew that they did not carry a gene for hereditary breast and ovarian cancer, it would not reduce their concerns about developing breast cancer.

If Latinas in my community were found to carry a gene for hereditary breast and ovarian cancer, it would jeopardize their insurance coverage or lead to problems with their employers. If Latinas in my community knew that they carried a gene for hereditary breast and ovarian cancer, it would leave them in a state of hopelessness and despair. If Latinas in my community knew that they carried a gene for hereditary breast and ovarian cancer, it would worsen their quality of life.

If Latinas in my community were found to carry a gene for hereditary breast and ovarian cancer, it would cause others to view them negatively. Latinas in my community already know their chances of getting breast cancer, so they wouldn't learn anything more from being tested.

Testing is not worthwhile because it could yield inconclusive about whether Latinas in my community carry a gene for hereditary breast and ovarian cancer. How confident do you feel about communicating with women you work with about hereditary breast and ovarian cancer? How confident do you feel about educating a patient about hereditary breast and ovarian cancer? How confident do you feel about conducting a community education session about hereditary breast and ovarian cancer?

How confident do you feel about identifying a patient at high risk for hereditary breast and ovarian cancer? How confident do you feel about identifying genetic services in your local area? How confident do you feel about referring a patient at high risk for hereditary breast and ovarian cancer to genetic services?

How confident do you feel about navigating a patient at high risk for hereditary breast and ovarian cancer through use of genetic services? In general, what language s do you read and speak? What was the language s you used as ? What language s do you usually speak at home? In which language s do you usually think? What language s do you usually speak with your friends? In what language s are the T.

Your closest friends are b. If you could choose your children's friends you would want them to be. This field is for validation purposes and should be left unchanged. Contact Information. Genetic counselor s , clinical geneticist s , on staff. Hereditary breast and ovarian cancer HBOC educational materials for organization staff.

How much have you heard or read about genetic counseling for inherited disease? A father can pass down an altered breast cancer gene to his children. Genetic counseling would help Latinas in my community understand more about their risks for cancer. Latinas in my community would not be able to pay for something like genetic counseling.

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